Missouri cut opioid prescribing by more than half and overdose deaths doubled anyway. Between 2013 and 2024 the state went from 93.3 opioid prescriptions per 100 residents to 44.3. That is a 53% drop. Over the same years the overdose death rate climbed from 17.9 per 100,000 to 35.8. The two lines crossed in 2018. Deaths have since fallen to a provisional 19.7, while prescribing kept dropping. Whatever drives the deaths, up or down, it is not the prescription pad.
The pattern is even sharper in our own market. St. Louis County dispensed 53.6 opioid prescriptions per 100 residents in 2024 and the city of St. Louis 69.3. The city rate is about three times New Jersey’s. The combined city-and-county overdose death rate peaked at 55.5 per 100,000 in 2022. That is higher than either state in this comparison.
New Jersey is the case study that started this debate, because it went first and went hardest. Below is that experiment, and what Missouri’s own numbers say about it.
Summary: Opioid addiction and the deaths it causes have cut average life expectancy in the US. It is now a major cause of death that can be prevented. Doctors prescribing too many opioids for pain fed this addiction. So many states began to limit opioid prescriptions, and New Jersey was the first. Sadly, limits at this stage do not seem to help. They seem to cause even more deaths. That is because people addicted to opioids keep using by buying illegal opioids. Data from New Jersey shows that a 35% drop in prescriptions came with a tripling of overdose deaths in the state.
The US is one of the few rich nations where life expectancy has fallen since 2015. This drop came after more than a century of steady gains. That is worrying, since the US is among the world’s top spenders on health care. Many believe overdose deaths from opioids caused at least part of this drop1. This shows the urgent need for effective opioid addiction treatment.
Data shows that deaths from opioid overdose have quadrupled in the US in the last 20 years. In 2019, drug overdose killed more than 70,000 people. More than 70% of those deaths came from opioids2.
Many of these deaths happen in people who once got opioids for a painful condition. Many of them got addicted and kept using, often with opioids bought illegally.
Many US states responded to this epidemic by limiting opioid prescriptions. But the data suggests this may not be the best way to fight the epidemic.
Did New Jersey’s opioid prescribing limits reduce overdoses?
New Jersey became the first US state to limit opioid prescriptions to 5 days for severe pain. So anyone who needs opioids longer must get a new prescription each time. The goal was to discourage long-term opioid use.
But experts doubt the rule is working. It seems many people buy illegal opioids instead. Some may even turn to street drugs to manage their health condition.
The new study shows that the risk of opioid overdose more than tripled from 2014 to 2019 among Medicaid patients. It rose from 120.5 per 100,000 person-years to 426.8. That is a big rise. The prescription limit also seems to have helped fentanyl spread. For example, fentanyl’s share of heroin seizures rose from 2% to 80% over the same period3.
Most of this rise came from overdoses of heroin and synthetic opioids. It also came with a higher risk of alcohol abuse, non-opioid drug use, and depression. It also came with a higher risk of blood-borne diseases like hepatitis C.
Experts agree that overprescribing fed the opioid epidemic at first. But limiting prescriptions at this stage does not seem to help. In fact, it raises the risk that people use more illegal drugs and catch certain infections.
This study shows that opioid prescribing has fallen 35% since 2015. Sadly, over the same time, overdose deaths have risen at an alarming rate, mostly from illegal fentanyl.
Where the data stands now — and what it looks like at home. Put the two lines on one chart and the debate stops being talk. Missouri cut opioid prescribing 53%, from 93.3 prescriptions per 100 residents in 2013 to 44.3 in 2024. Over the same stretch the overdose death rate went the other way. It rose from 17.9 per 100,000 in 2015 to 35.8 in 2022, and the lines cross in 2018. Then it fell to a provisional 19.7 in the 12 months ending December 2025. New Jersey ran the same experiment harder. It cut prescribing 59% to 23.7 and got the same shape. Deaths doubled to 32.5 by 2021, then fell to 16.7. In our own market the prescribing numbers are even higher. St. Louis County dispensed 53.6 per 100 residents in 2024 and the city of St. Louis 69.3, roughly three times the New Jersey rate. The local death rate peaked at 55.5 per 100,000 in 2022, above either state. Two conclusions hold across the whole series. First, prescribing and overdose deaths moved on their own for a decade, in both directions. So cutting prescriptions was never going to be the whole answer. Second, the recent drop in deaths came while prescribing was still falling. So something other than the prescription pad is driving it. Treat the person, not the prescription count.
Researchers also say overdose survivors need much more attention, because they live with many disorders. Data from 2019 shows that half of them had major depression, and about 39% had alcohol abuse. Other common conditions include high rates of hepatitis C, bipolar disorder, cannabis abuse, sedative use, and schizophrenia.
The study’s authors also noted that many other US states have limited opioid prescriptions. This caused the biggest drop in opioid prescriptions in the last 20 years. Still, overdose deaths keep rising sharply each year, with 93,000 deaths in 2020. Most of these deaths were linked to illegal fentanyl and other opioids.
Frequently asked questions
What is New Jersey’s opioid prescription limit?
New Jersey was the first state to limit opioid prescriptions for severe pain to 5 days. Anyone who needs opioids longer must get a new prescription each time. The rule was meant to discourage long-term opioid use. Yet prescribing fell 35% after 2015, while overdose deaths rose sharply, mostly from illegal fentanyl.
Why did overdose deaths rise after opioid limits?
Many people who were already addicted kept using. They bought illegal opioids or turned to street drugs. Among New Jersey Medicaid patients, overdose risk more than tripled from 2014 to 2019. It rose from 120.5 to 426.8 per 100,000 person-years. Fentanyl’s share of heroin seizures rose from 2% to 80% over the same period.
How many opioid prescriptions are written in St. Louis?
St. Louis County dispensed 53.6 opioid prescriptions per 100 residents in 2024, and the city of St. Louis 69.3. That is about three times New Jersey’s rate. The combined city-and-county overdose death rate peaked at 55.5 per 100,000 in 2022. That is higher than either Missouri or New Jersey in this comparison.
What do opioid overdose survivors need?
Survivors usually live with more than one disorder. In 2019 data, half had major depression and about 39% had alcohol abuse. High rates of hepatitis C, bipolar disorder, cannabis abuse, sedative use and schizophrenia were also common. That is why care has to treat the whole person, not the prescription count.
Related reading
Prescription Opioids Still Fuel the Opioid Crisis · Buprenorphine Treatment Gaps Raise Overdose Risk · No Outcome Gains with Broader NP Opioid Authority
References
1. DeWeerdt S. Tracing the US opioid crisis to its roots. Nature. 2019;573(7773):S10-S12. doi:10.1038/d41586-019-02686-2
2. Understanding the Epidemic | CDC’s Response to the Opioid Overdose Epidemic | CDC. Published October 2, 2021. Accessed November 9, 2021. https://www.cdc.gov/opioids/basics/epidemic.html
3. Crystal S, Nowels M, Olfson M, Samples H, Williams AR, Treitler P. Medically treated opioid overdoses among New Jersey Medicaid beneficiaries: Rapid growth and complex comorbidity amid growing fentanyl penetration. Journal of Substance Abuse Treatment. 2021;0(0). doi:10.1016/j.jsat.2021.108546